Prince William County Authorization Form

YES! I want to join with other Prince William County employees to make my voice heard.

I authorize SEIU VA 512 and its successors or assigns (collectively, “SEIU VA 512”) to act as my representative in collective bargaining with my employer, Prince William County(“the County”), over wages, benefits, and other terms/conditions of employment, and as my exclusive representative where authorized by law. I understand that when Prince William County employees win the right to collectively bargain, SEIU VA 512 will use this authorization card to seek an election or obtain recognition from the County.

? Take future action with a single click.
Log in or Sign up for FastAction

Contact Information

First Name Last Name

Street Address Address Line 2 (Optional)

Postal Code City State/Province

Personal Email Personal Mobile Phone

Yes, sign me up for email updates.

Remember me so that I can use FastAction next time.

(Optional)

Additional Information

Department

Job Title

Worksite

By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

Please Enter Today's Date

Signature